Hermano I Krebs1, Michael Krams, Dimitris K Agrafiotis, Allitia DiBernardo, Juan C Chavez, Gary S Littman, Eric Yang, Geert Byttebier, Laura Dipietro, Avrielle Rykman, Kate McArthur, Karim Hajjar, Kennedy R Lees, Bruce T Volpe. 1. From the Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge (H.I.K., L.D.); Janssen Research & Development, Titusville, NJ (M.K., A.D.B.); Covance, Princeton, NJ (D.K.A., E.Y.); Biogen-Idec, Experimental Medicine, Cambridge, MA (J.C.C.); GSL Statistical Consulting, Ardmore, PA (G.S.L.); BVBA Bioconstat, Gent, Oostakker, Belgium (G.B.); The Burke Medical Research Institute, White Plains, NY (A.R.); Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom (K.M.A., K.H., K.R.L.); Department of Neurology, University of Duisburg-Essen, Essen, Germany (K.H.); and The Feinstein Institute for Medical Research, Manhasset, NY (B.T.V.).
Abstract
BACKGROUND AND PURPOSE: Because robotic devices record the kinematics and kinetics of human movements with high resolution, we hypothesized that robotic measures collected longitudinally in patients after stroke would bear a significant relationship to standard clinical outcome measures and, therefore, might provide superior biomarkers. METHODS: In patients with moderate-to-severe acute ischemic stroke, we used clinical scales and robotic devices to measure arm movement 7, 14, 21, 30, and 90 days after the event at 2 clinical sites. The robots are interactive devices that measure speed, position, and force so that calculated kinematic and kinetic parameters could be compared with clinical assessments. RESULTS: Among 208 patients, robotic measures predicted well the clinical measures (cross-validated R(2) of modified Rankin scale=0.60; National Institutes of Health Stroke Scale=0.63; Fugl-Meyer=0.73; Motor Power=0.75). When suitably scaled and combined by an artificial neural network, the robotic measures demonstrated greater sensitivity in measuring the recovery of patients from day 7 to day 90 (increased standardized effect=1.47). CONCLUSIONS: These results demonstrate that robotic measures of motor performance will more than adequately capture outcome, and the altered effect size will reduce the required sample size. Reducing sample size will likely improve study efficiency.
BACKGROUND AND PURPOSE: Because robotic devices record the kinematics and kinetics of human movements with high resolution, we hypothesized that robotic measures collected longitudinally in patients after stroke would bear a significant relationship to standard clinical outcome measures and, therefore, might provide superior biomarkers. METHODS: In patients with moderate-to-severe acute ischemic stroke, we used clinical scales and robotic devices to measure arm movement 7, 14, 21, 30, and 90 days after the event at 2 clinical sites. The robots are interactive devices that measure speed, position, and force so that calculated kinematic and kinetic parameters could be compared with clinical assessments. RESULTS: Among 208 patients, robotic measures predicted well the clinical measures (cross-validated R(2) of modified Rankin scale=0.60; National Institutes of Health Stroke Scale=0.63; Fugl-Meyer=0.73; Motor Power=0.75). When suitably scaled and combined by an artificial neural network, the robotic measures demonstrated greater sensitivity in measuring the recovery of patients from day 7 to day 90 (increased standardized effect=1.47). CONCLUSIONS: These results demonstrate that robotic measures of motor performance will more than adequately capture outcome, and the altered effect size will reduce the required sample size. Reducing sample size will likely improve study efficiency.
Entities:
Keywords:
biomarkers; motor skills; robotics; sensory motor performance; stroke
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